The end of the 'Marcus Welby, M.D.' era of patient care

STATEN ISLAND, N.Y. — As many of you may recall, “Marcus Welby, M.D.” was a medical drama series on TV during the 1970s. The story line revolved around a family practitioner, namely, Marcus Welby. In the series, we were introduced to a physician whose life revolved around his patients who, in each episode, were faced with conflicts, drama, and resolution involving some very important medical diagnosis or crisis.

The drama showed Dr. Welby caring for one patient at a time. It demonstrated a physician going “above and beyond” for his patients.

Often times, he made house calls.

Dr. Welby’s office ran very smoothly with only one employee, Consuelo Lopez, who served as both secretary and nurse and who was very proficient at her job.

LIFE TODAY

To those of us who practice medicine today, the above scenario would be a dream. Unfortunately, the experience for today’s physicians and patients is less than optimal.

Medical offices must employ anywhere from two to 10 staff members (for each physician in the practice) in order for the practice to run smoothly.

Today, the patient experience goes something like this: It begins with difficulty scheduling an appointment in an expeditious manner. Then, when the appointment occurs, there may be a long wait because many physicians are forced to see more and more patients due to the decreased reimbursement from insurances, and the shortage of primary care physicians (PCPs).

As if this is not frustrating enough for the patient, many insurance companies require that the PCP obtain pre-approval before a specialist can see a patient. This means offices need to hire more and more staff to follow the burdensome, time-consuming process of obtaining pre-approval for referrals.

Some testing requires authorization and can take anywhere from five to 25 minutes on the phone pleading with the insurance companies. Some times, the companies insist on speaking directly to the physician, which takes more time away from patient care, and provides no additional reimbursement to the physician’s office.

LESS CHOICE

A more frequent phenomena is that many of the specialists, because of low reimbursements, have chosen not to participate in several medical plans. This gives some patients no other choice but to travel to another borough when they need to be seen by a specialist.

As if all these steps are not enough, enter the concept of deductibles and co-pays. Some patients feel because they are paying so much for their premiums, they shouldn’t have to spend any more money for each and every visit to the physician’s office.

However, the “co-pay” is a contractual responsibility between the patient and the insurance company to pay for a portion of the physician’s services and the physician is bound by law to collect the contracted amount. Often, this is a troublesome task for a staff member whose responsibility it is to seek payment from the patient. Worse yet, in many cases, it is a financial burden on the patient to pay it.

It seems as we are entering the dawn of “Obamacare,” patients are feeling more and more disgruntled with the system. Primary care physicians listen to the concerns of their patients every day in their offices.

AGENT FOR CHANGE

But, change will only come if we can make our voices heard. Physicians advocate every day for the best health care for our patients. We do this at a local level, as well as state level meeting face-to-face with our elected officials in Albany to help them understand the barriers physicians face in providing quality medical care to our patients. Many of us have also discussed concerns on a national level with our representatives in Congress and other elected officials.

You, the patient, clearly would be better served if we, the physicians, weren’t forced to spend so much time and effort on the issues imposed upon us by the insurance companies. Your doctor might then, like Dr. Welby, have the luxury of spending his or her time actually caring for the patient.

If you have had a particular problem with your insurance company, or have a unique story to tell, we would like to hear from you. Your story can be sent to my attention: Dr. Ralph Messo, Richmond County Medical Society, 460 Brielle Ave., Administration Building, Room 202, Staten Island, N.Y. 10314.

This column is provided by the Richmond County Medical Society. Dr. Messo is a past-president of the Society and maintains a private practice in Eltingville. He is the director of Internal Medicine/Pediatric Education at Richmond University Medical Center, director of Medical Education for Touro College of Osteopathic Medicine (TOUROCOM) at Staten Island University Hospital, and an adjunct clinical professor at TOUROCOM, Harlem.